Political pressures impacted state health exchange

SPRINGFIELD (AP) – Most states led by Democratic governors have opted to run their own online health insurance marketplaces as part of the Affordable Care Act.

But in President Barack Obama’s home state, Gov. Pat Quinn pushed unsuccessfully for 3 years for a state-run marketplace, so Illinois residents now must rely on a crippled federal website.

With elections ahead for vulnerable Democrats – all 118 members of the House are up for re-election in 2014 – experts say it’s unlikely there’s enough support to get a state-run marketplace. The Democrat-led chamber hasn’t yet approved the legislation.

“I just don’t see the political will to do it until we have distance from 2014 and the rollout of this law,” said Laura Minzer, executive director of the Illinois Chamber of Commerce’s HealthCare council.

That “political will” was something that couldn’t be mustered last spring in the chamber. State Rep. Robyn Gabel, an Evanston Democrat, sponsored a bill creating a state-based exchange that passed the Illinois Senate in May with no Republican votes, but the measure has stalled in a rules committee.

“There were some people who wanted to see how the Affordable Care Act was going to roll out,” Gabel said, pinning the lack of vote as “political on a bigger scale.”

The rollout of the federal Healthcare.gov website in October was marred by glitches and technical problems. Officials have said they hope to get the website working smoothly by the end of this month, though Obama said last week that he couldn’t guarantee it would be bug-free by then.

Only 1,370 Illinois residents were able to select an insurance plan in the federal marketplace’s first month, according to figures released recently by the Obama administration. Nationally, 106,185 Americans were able to select plans.

Those figures are a fraction of the 7 million people that the nonpartisan Congressional Budget Office predicted would be enrolled by the end of 2014. For the 16 states and the District of Columbia that developed their own websites, a much higher percentage of those declared eligible were able to select a plan, though there have been some problems with a few state-run exchanges.

Advocates and the Quinn administration have worked since 2011 to put in place legislation to create a state-based health insurance marketplace to no avail.

Rep. Frank Mautino, a Spring Valley Democrat, said the most recent piece of legislation sent over to the House “needed a lot of work.” Mautino, a top House Democrat, said he kept a running list of about 20 technical items that needed fixing in the legislation, citing problems with the setup of the board that would oversee the marketplace – including the fact that members’ terms would all expire simultaneously. He also said a number deadlines contained in the bill had passed, and there was a lack of protections if program costs were higher than expected.

The General Assembly was also dealing at the time with several other issues – gay marriage legislation, pension reform, the budget and court-mandated gun control laws.

Steve Brown, spokesman for House Speaker Michael Madigan, cited a “lack of consensus” for a state program as reason why the legislation didn’t move through, though he noted Madigan is working closely with Mautino and plans to “assess things on a month by month basis.”

Still, Mautino acknowledged, “There’s always a political element.”

Democrats across the country, those up for re-election in particular, are working to distance themselves from the health overhaul in the wake of the website blunders.

Few state senators are up for re-election next year, but a number of the state’s Democratic majority expect general election challenges from Republicans hoping to take back moderate districts.

“A lot of this comes down to if it’s politically advisable at this point to put them in a position that might play into an election,” Minzer said. “The vote is tied to a law that has a deep public opinion divide.”

Even Quinn, who is looking for his second full term, knows he’ll have to answer questions as the campaign heats up. When asked if the General Assembly had made a mistake not to authorize a state-run exchange, Brooke Anderson, the governor’s spokeswoman, provided a statement from Quinn noting only that “clearly the federal implementation needs improvement. We’re reviewing our options to determine the best path forward for health care consumers in Illinois.”

Gabel said she plans to again call the bill in the spring session, so there is enough time to establish a state-based exchange for 2016, as Illinois can use the federal website for another year before transitioning into its own plan. She wasn’t sure how the March primary elections would impact the scheduling of a vote.

“I know we need to get it done this session,” she said.

Mautino said he and Peoria Democrat David Koehler, the Senate sponsor of the state-run exchange legislation, have held meetings in recent weeks over the issue. However, he said, he believes it’s wise to let the federal system work out the kinks first.

“Right now, taking ownership of a system in trouble and trying to work it backward is a large task,” he said.